Compartment Syndrome

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KEY POINTS

• Compartment syndrome is pain and swelling caused by a buildup of pressure inside an enclosed space (compartment) that contains muscles, nerves, and blood vessels.
• Compartment syndrome that comes on suddenly must be treated right away. You will need surgery to release the pressure and bring blood flow back to the area.
• The pain from compartment syndrome caused by exercise will usually go away in a few weeks with self-care. Your provider may recommend stretching and exercises to help you heal.

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What is compartment syndrome?

Compartment syndrome is pain and swelling caused by a buildup of pressure inside an enclosed space in your body called a compartment. This problem happens most often in the:

• Lower leg (calf)
• Upper leg (thigh)
• Lower arm (forearm)

What is the cause?

Groupings of muscles, nerves, and blood vessels are in enclosed spaces in your legs, arms, and other parts of your body. These groupings are called compartments and the tough tissue surrounding and enclosing them is called fascia. After an injury, blood or fluid may collect inside a compartment. Tissues inside the compartment may swell. The fascia surrounding the compartment does not stretch easily, so fluid and swelling increase the pressure inside the compartment. The pressure can get so high that it cuts off the flow of blood and damages ligaments, muscles, and nerves.

The most common type of compartment syndrome happens quickly and is called acute compartment syndrome. It is often caused by a broken arm or leg. It may also be caused by pressure on the outside of the arm or leg from a tight cast or from lying in one position for a very long time.

Another type of compartment syndrome that can be caused by exercise is called chronic compartment syndrome or exertional compartment syndrome. Pressure inside a compartment can build up over time from overuse of your muscles. People who run a lot have the highest risk of this syndrome.

What are the symptoms?

The symptoms are usually in the forearm, thigh, or calf. They may include:

• Pain that is worse than you might expect from the injury
• Swelling and skin tightness
• Weakness
• Tenderness over the front of the shin
• Tingling or numbness of the leg, foot, or hand
• Foot drop, which means you cannot lift your toes, so you have to limp to keep your foot from dragging
• Pain when you flex or point the big toe

If you are a runner with exertional compartment syndrome, you may find that the pain starts after you have run a certain distance or with a certain level of intensity.

How is it diagnosed?

Your healthcare provider will examine you and ask about your symptoms, activities, and medical history. You may have a needle test. This test uses a needle attached to a device that measures the pressure in your tissues while you are resting and after you exercise.

How is it treated?

Compartment syndrome that comes on suddenly must be treated right away. You will need surgery to release the pressure and bring blood flow back to the area.

The pain from compartment syndrome caused by exercise will usually go away in a few weeks with self-care. Your provider may recommend stretching and exercises to help you heal. If rest and self-care don’t relieve your symptoms after 12 weeks, your healthcare provider may suggest surgery.

How can I take care of myself?

To keep swelling down and help relieve pain:

• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the painful area every 3 to 4 hours for up to 20 minutes at a time.
• Keep the injured area up on pillows so that it is above the level of your heart when you sit or lie down.
• Take an anti-inflammatory medicine, such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take this medicine for more than 10 days.

Follow your healthcare provider's instructions. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent compartment syndrome?

Here are some of the things you can do to help prevent compartment syndrome:

• Do warm-up exercises and stretching before activities.
• Gradually increase your exercise level when you start new activities that require constant use of your lower arms or legs.
• If you have a cast or splint around your arm or leg, contact your healthcare provider if the cast or splint starts to feel tight, or your fingers or toes start to swell, get cold, or get pale.